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. Author manuscript; available in PMC: 2022 Jan 11.
Published in final edited form as: Semin Nephrol. 2021 Nov;41(6):487–504. doi: 10.1016/j.semnephrol.2021.10.002

Table 3.

Social and Environmental Drivers of Kidney Disease Self-Management Behaviors

Patient-Reported Self-Management Behavior(s) Studied Study Study Population, Sample Size (N), Study Design Additional Notes and Details of Effect Size if Reported
Social support
Summary of self-management behaviors Kahn et al, 201569 CKD (N = 34)
Cross-sectional; qualitative		 NA
Many participants were uninsured and underinsured
Washington et al, 2016106 Hemodialysis (N = 107)
Cross-sectional; mixed-methods		 NA
Chen et al, 201837 CKD (N = 410)
Cross-sectional; quantitative		 Standardized β = 0.59
R2 = 0.52 for social support, age, health literacy, and marital status
Xie et al, 201978 Kidney transplant (N = 483)
Cross-sectional; quantitative		 r = 0.30 for association between social support and self-management
Exercise and physical activity Williams et al, 1991103 Hemodialysis (N = 40)
Cross-sectional; quantitative		 75% who engaged in a structured physical activity program reported having encouraging support groups
Goodman et al, 200446 Hemodialysis (N = 50)
Cross-sectional; quantitative		 12% reported a lack of social support
Clarke et al, 2015104 CKD (N = 36)
Cross-sectional; qualitative		 NA
Kendrick et al, 2019105 CKD (N = 41)
Cross-sectional; qualitative		 NA
Social support from family was a barrier in this study
Liu et al, 202091 Hemodialysis (N = 10)
Cross-sectional; qualitative		 NA
Medication adherence Van Camp et al, 2014101 Hemodialysis (N = 135)
Prospective (2 mo); quantitative		 OR, 2.94 (95% CI, 1.23–7.03) for association between living with a partner and phosphate binder adherence
Scheel et al, 201829 Kidney transplant (N = 330)
Cross-sectional; quantitative		 Standardized β = −0.035
OR, 0.96 (95% CI, 0.93–1.00)
Visit adherence Goldade et al, 201194 Kidney transplant (N = 39)
Cross-sectional; qualitative		 NA
Motivation was a barrier to visit adherence
Been-Dahmen et al, 2018102 Kidney transplant (N = 41)
Cross-sectional; qualitative		 NA
Fluid control adherence Christensen et al, 1992100 Hemodialysis (N = 78)
Cross-sectional; quantitative		 Using multivariate analysis of covariance, main effects were found for family support (6.16) on intradialytic weight gain after adjustment for diabetic status
Pang et al, 200199 Hemodialysis (N = 92)
Cross-sectional; quantitative		 Unstandardized β = −0.54
R2 = 0.38 for social support, comorbidity, income
Health care provider support
Summary of self-management behaviors Lin et al, 201128 Kidney transplant (N = 101)
Cross-sectional; quantitative		 Standardized β = 0.22
R2 = 0.37 for age, post-kidney transplant time, health care provider support, financial satisfaction
Hwang et al, 202068 CKD (N = 20)
Cross-sectional; qualitative		 Therapeutic alliance between patients and providers were facilitators of self-management
Exercise and physical activity Clarke et al, 2015104 CKD (N = 36)
Cross-sectional; qualitative		 NA
Young et al, 2015109 Hemodialysis (N = 24 patients and 9 dialysis unit staff)
Cross-sectional; Qualitative		 NA
Thompson et al, 2016108 Hemodialysis (N = 25 patients and 11 dialysis unit staff)
Cross-sectional; Qualitative		 NA
Visit adherence Saran et al, 2003110 Hemodialysis (N = 3,359)
Prospective cohort; quantitative		 OR, 0.75 (95% CI, not reported) for association between kidney dietician and lower intradialytic weight gain
Fluid control adherence Saran et al, 2003110 Hemodialysis (N = 3,359)
Prospective cohort; quantitative		 OR, 0.94 (95% CI, not reported) for association between trained staff and fewer skipped treatments
Yokoyama et al, 2009111 Hemodialysis (N = 71)
Cross-sectional; quantitative		 OR, 2.51 (95% CI, 0.99–6.34) after adjustments for age, sex, diuretic use, education, dialysis duration, dialysis adequacy (Kt/V), body mass index, diabetes status
Environment
Summary of self-management behaviors Lin et al, 201128 Kidney transplant (N = 101)
Cross-sectional; quantitative		 Standardized β = 0.22
R2 = 0.37 for age, post-kidney transplant time, health care provider support, financial satisfaction
Exercise and physical activity Goodman et al, 200446 Hemodialysis (N = 50)
Cross-sectional; quantitative		 50% reported weather-related concerns; 12% reported a lack of sidewalks
Kendrick et al, 2019105 CKD (N = 41)
Cross-sectional; qualitative		 NA
Song et al, 201992 Hemodialysis (N = 44)
Cross-sectional; qualitative		 NA
Medication adherence Kadowaki et al, 2014122 Kidney transplant (N = 315)
Cross-sectional; quantitative		 16% had difficulties continuing oral immunosuppressants due to supply delay and drugs being lost in the tsunami
Visit adherence Chenitz et al, 201493 Hemodialysis (N = 30)
Cross-sectional; qualitative		 NA
Brar et al, 2014113 Hemodialysis (N = 79 centers)
Cross-sectional; quantitative		 Providers at 77% of centers (consisting of nephrologists, surgeons, social workers) reported transportation as the primary barrier to dialysis nonadherence
Chan et al, 2014114 Hemodialysis (182,536)
Prospective (5-y); quantitative		 Using a van for transport: OR, 1.21 (95% CI, 1.16–1.25) for missed visit
Travel time >17 min: OR, 1.10 (95% CI, 1.07–1.15) for missed visit
Snowfall: OR, 2.68 (95% CI, 2.60–2.77) for missed visit

Abbreviations: CI, confidence interval; CKD, chronic kidney disease; NA, not applicable; OR, odds ratio.